 We'll begin by asking our panelists if they have any responses to Dr. Osterholm's talk. Dr. Bishop, can you help us out, ladies and gentlemen? We need to be quiet, please. Well, if I wasn't scared before, I am now. And the question I have for Michael is this is clearly a global problem, which I presume requires a global solution. And where should that reside? Where should the leadership be coming from? Is WHO up to this? Can it be made up to it? Or if not, how are we going to get this done? Well, first of all, let me just say that you're talking about a solution to all the emerging infections, or I'll even, for that matter, just go with pandemic flu. What we don't have today is a political will. You know, for the kids in the room, let me just say I'm old enough to remember, not realizing at the time the significance of the event. On May 21st, 1961, when a young newly elected president went up to Capitol Hill and said, we're going to go to the moon by the end of the decade because we're Americans and we can do it. It's tough. It'll be hard, but we're going to do it. And we rallied the best in science and the best in purpose, and we did it. A year and a half ago, President George Bush announced that he would put $8 billion towards jump-starting vaccine for influenza work, which, if you know anything about it, is really a drop in the bucket of really talking about research development and actually developing production capacity. Senate Majority Leader Bill Frist, who is a Republican, who is a well-known expert in the area of infectious diseases, said we need a Manhattan Project because that's important. Last December, the House Republicans gutted that bill and gave only half the amount. And I was up there and said, this is just another Y2K. You're up here all the time asking for things. There was no leadership. That's not a partisan issue. On a worldwide basis, we see the same thing. So I believe that until we have leaders that are willing to stand up, and I give, again, Bill Gates and Bill Clinton right now and Warren Buffett, thank God we have them. But in the philanthropic world today, it's very much an issue of a one-item issue because they want to get something to get their arms around. And you know what, frankly, looking at vector control or looking at the vaccine capacity for manufacturing vaccines, they're all so big issues. So it's easy to focus and target on HIV-AIDS. And I'm glad they are, but that's it. So none of this other stuff is being addressed. There is no other advocacy groups out there for many of these things. And that's the problem we have today. Dr. West. So assuming that we could change the political will and there was a significant investment in battling infectious disease, what are some key advances in science and technology that could really make a big difference? Well, let me start and say at the very beginning it's not about science and technology as we think about it. Fresh water, safe food, and safe communities are the very basis for preventing infectious disease transmission. Healthy babies. The things that we've known how to do for a long time. The things that we enjoy in this country. If you want to bring population control out of the front burner, go out and do those basic things. Decrease infant mortality and you increase total fertility. And I think that's part of the problem is it's not a magic bullet solution. It's just hard work. You know, there are some in the audience that asked and I was going to cover this ahead of time. Last Friday the World Health Organization came back out and urged the reuse of DDT from vector control before everybody groans. I have been very supportive of that. And I tell you that because as somebody who is very much involved in the wildlife restoration and so forth, what Rachel Carson talked about which was right on target was the agricultural use of DDT which accounted for 99.999% of all DDT. If we could bring back DDT again into the huts of rural Africa and rural Asia, which is one of the safest pesticides to humans we've ever known and would have no residual impact if used appropriately on wildlife, we could dramatically decrease it. That's not expensive to do. It's those kinds of things we need to do and we're not doing them. And I think that the last piece I would just say is we've made some major inroads in this world with vaccines and antibiotics over the last four decades. That infrastructure is going. At one time we had over 40 vaccine manufacturer companies in this country. Today we're down to basically two large conglomerates. And when they can make more on selling Viagra in one year than the entire vaccine industry makes collectively in 10 years, you ask yourself, why ever get into vaccines? We have no will there. So it's these basic infrastructures. It's not even new science. It's just taking the science we know and applying it with some real resources. Dr. Callahan. I've had a longstanding interest in future problems and how you deal with problems that are not quite here, but you have to make the preparation now. And we do that in general very poorly. And I recently had the occasion to write a paper on the flu pandemic and two things struck me. One was, how do you get the media to handle an issue like this to keep it alive over a long period of time? And secondly, at least six or eight months ago, there were some rather significant scientific figures that said, well, this is all being overblown. And what do you do? And that's true with global warming, too. But these were rather substantial figures who were doubting this. And then the third question is, first, how do you deal with the media? What about the scientific descent? And I suppose thirdly, the fact that right now we're overloaded with future issues. I'm going to talk about the future of Medicare. I'm worried about that one. Global warming, terrorism. Everything you're saying about this would apply to terrorism. The cities aren't preparing. We're not doing enough, et cetera, et cetera. Now, how do you cope with all of this? Unanswerable questions, but I throw it to you anyway. One of the absolute gifts of being involved with an incredible meeting like this is getting questions through a very august group. Well, first of all, let me just say the media. When we put on our summit last February here that our center did, and we had this incredible response from business sectors across the world, there were two business sectors out of 20 some that didn't show up at all. One was the airlines industry that said across the board if we have a pandemic, we're screwed. It doesn't matter. No, it happens. The second group that didn't show up was the media. And we had many, many media figures, reporters who begged their editors and their management to come because they were concerned how they would have continuity of business reporting the news. And I think the media today is one of the least prepared of any organizations out there. And there is not good editorial policy. If it ain't a crisis, then they're not going to deal with it in the sense of every day. Let me give you an example. On May 14th, Sunday this past year, Don McNeil, one of the science reporters from The New York Times, and I have a slide of this which I didn't show today, wrote a piece in The New York Times which basically challenged what you just said about bird flu in the idea that this was even going to happen calling into question all these issues. Unbeknownst to Don, there was a cluster beginning to emerge in Indonesia that actually did get to one third generation transmission case. And it was a very serious situation and it scared the hell out of us, frankly. Well, Don got wind of that by Wednesday and wrote a story on Thursday. Now, this is the 18th of May. Again, above the fold, front page. If you read that, you thought the pandemic had begun. He then wrote a story two weeks later that negated everything he wrote in the May 14 story. I mean, it was, again, same reporter, same newspaper, the one newspaper I rely on to. And it shows you how schizophrenic the media is on this. So I think if you look at WHO, you look at the body of scientists out there who worked in this area, no one challenges it. Again, pandemics are like earthquakes, hurricanes, and tsunamis, they occur. In 1918, most of our communities produced their own food in their local area. We didn't count on drugs from around the world. We didn't have a need for a lot of that. Today, we are so dependent on that the one-off, the two-off implications are huge, and that's where it's different. Finally, your last piece, you know, the issue of, I think the question is, how do we keep this going? What are we going to do about this? I don't have an answer except we just keep hitting our head and hitting our head. I wrote a piece in Foreign Affairs, which, by the way, from my political science major, I never had completed my senior paper. I now am told by Luthor College that I'm good to go with them after getting a paper from Foreign Affairs. And I wrote, laid out in that paper, what if it happened tonight? What would we have to do? What if it was a year from now? What if it was 10 years from now? And all the things that we laid out in a very proactive, doable way, virtually none of those have been done in the last year. And when I go to bed at night, I just think we just wasted another year. Dr. Aaron, anything at this point? Just one question. I think all of us were shocked by the litany of risks and dangers we confront. It would be nice to have, at least in a particular area, a course of action described in a bit of detail as to what we could do or should do in order to deal with it. And I'd like to put one on the table. You stress the insufficiency of vaccines, the fact that American companies, by and large, don't want to get into the business because, on the one hand, it's not very profitable when you sell it and face, in addition, very considerable liability risks. What steps should be taken by the federal government, by state governments, by business? What would you tell a candidate running for office that he or she should support? Well, you know, one of the problems of also being in a meeting like this is a thing called time. If you give me a day, I'd be happy to sit down with you and give you a blueprint for every one of these because we've actually worked them out. I'll tell you a short description. The issue on vector-borne disease right now, two very important things is vector-borne diseases. We've had no reinvestment in pesticide research because, again, there's this problem with public health pesticides are not a viable product. You know, let me just back up and say, if you look in the state of Minnesota, one of the most well-funded fire departments in this state is the Minneapolis-Saint Paul International Airport Fire Department. There has not been a plane crash on that reservation since the inception of the airport of any known. The two major planes that went down went down to Minneapolis in the 1950s and they were both covered by the Minneapolis Fire Department. The point is, though, because as someone who flies in and out of there more than I ever want to, I'm really glad they're there. So if it happens, they're on scene right now and can deal with it like we saw in Toronto last year. As a community, we elect to pay for that. Even though you've got to argue the most important thing they do on a day-to-day basis is send the ambulance to somebody who needs it. We have to make a conscious decision who we are as a society by what we invest in. You know, I'm not going to sit here and tell you investing in, you know, a less war or defense to things. I don't know all that, but I know the price we're going to pay. So if we invest it right now in vector control through increased pesticide research and application, through solid waste issues, and probably last but not least is just the feet on the ground. We need a generation of people to do what the 60s did. We need a peace corps as a world. Instead of sending guns, send people. And we will make a bigger difference, I believe, around the world. Now, that's one example for vector control diseases. I'm not even talking about vaccines. It would be ideal if you could get vaccines. I could go through every one of these, whether it's water. Today, Dr. West asked about the water. There is no rocket science right now. We have no program, USAID and all the other countries of the world have continued to cut their resource support for the developing world for something as simple as water. Read the New York Times piece. You'll see what I'm talking about. It's not me saying it. It's the experts. So the point is, if we just invest it in that, that's not investing in big, tough technology. Surely the vaccine issue is a challenge. How do you get a workable business model? Surely pandemic planning is a challenge. How are you going to deal with all the debt? How are you going to deal with healthcare? I mean, you and your own, I hope in your talk, you will cover the fact that, in this country, we diverted 500,000 people from the closest emergency room of choice to another emergency room because our emergency rooms are overfilled. I was at a meeting Tuesday night in a major community in this country where the chief of internal medicine at a very prestigious hospital could not get his patient admitted to the hospital because there were no beds. And this is not flu season. Those are the kinds of things we need to deal with. We have time for just a couple questions from the audience here. Actually, we've covered most of the questions that we have here, but let's try this one here. A subset of parents who are homeschooling choose not to immunize their children. Would you please comment? Well, I very much support the concept of personal choice. I must say that it is a very, very, very wrong decision to do. Immunization has gotten us a long ways in this country, and there are many, many kids every night they get to go to bed and you get to kiss them good night. And because of the fact that they were vaccinated. I sit here in this community. I had just wished we'd had routine meningitis immunization 15 years ago because I wouldn't have to be at the bedside of the young boy who died. And one of the problems with this is that we don't see the impact of a vaccine preventable disease situation until enough people don't get vaccinated and then it returns. And so while I understand this idea of personal choice and so forth for the community good and frankly for the good of the individuals, I believe that every child should be adequately vaccinated and I believe it's both for the best interest of the child and clearly it's for the best interest of the community. Yes, Dr. Bishop. I think there's another point that needs to be made. This is on my mind because I lectured a medical student about these very issues. The folks who don't have their children vaccinated can do that with some sense of safety because everybody else has. Don't forget that. That's a sort of practical question. I plan to lead a church group to East Africa in January. What precautions do we take? Or should we stay home? Quite to the contrary, I would urge you to go. If anything, we are so American centric that any time you can open the eyes of our community to the world, that's a great thing. Now, be smart. Go through an appropriate travel clinic. Make sure you know what immunizations you need, what medications you need. Know your communication plans. And as someone who travels around the world all the time, I wish we did more of it. And I think you can do it safely and I think you can do it in a way that is responsible. Okay. One last question to kind of follow up on one that we had before. What are you doing within your own family in anticipation of a pandemic? This is a very difficult question. Not that I will answer, but because it really goes to the heart of who we all are. I have a daughter who's a third year resident in Pediatrics at the University of Minnesota. I can't begin to tell you as a father how proud I am of her and what it means to be chief resident next year. I have every hope and every belief that when the next pandemic comes, she'll be one of the heroes in the front line that she's done already. And then a switch hits. And I sit here as a father who loves my daughter more than I can put into words. And I feel like a father watching his daughter get into the front seat of a car with a drunk driver about to go down the freeway the wrong way. And I hope she never shows up for work. Now I wrestle with that all the time. I know I will be in the middle of pandemic influenza. Our family's made a conscious decision, which is one I hope you'll be able to honor at the time is I will not return home for potentially weeks to months because I could anyone given night bring it back home with me, not knowing I'm infected until the following morning when I wake up sick and have infected my family. My family intends to try to live it out. We have food. We happen to live in a private well system. We have stockpiled in 95 respirators and we are very fortunate we have no one in my family so that I don't have to worry about that. But that's not a luxury many other families and many other people have. The hardest part is going to be if you really try to not infect your family members and you're working in this area healthcare workers are going to have some major challenges in their hands of what to do and how to do it. And it's guys like Dan over here who are going to help provide us with more insight as to how we begin to discuss those issues because they really are key ones. Well, speaking of Dr. Callahan we'll be hearing him at three o'clock and I think it's time for us to sort of adjourn for a half an hour and we'll really assemble to adjourn. Thank you.